Temporal Evolution of Left Main Coronary Artery Stenosis De Novo Presentation: Trends in Coronary Angiography and Clinical Characteristics (LM-EVOLUTION Study)

Background: Cardiovascular diseases evolve over time; this may affect treatment. We investigated angiographic trends in patients presenting with de novo left main coronary artery (LM) stenosis over a decade.

Methods: Clinical records and all consecutive coronary angiograms performed in our Institution between 2011 and 2020 were reviewed to identify subjects with newly diagnosed significant (≥ 50% lumen diameter reduction by quantitative angiography) LM stenosis. Values of the overall SYNTAX score (SS), LM lesion SS (LM-SS) and SS for lesion(s) beyond LM (non-LM-SS) were assessed as per angiographic core labolatory protocol.

Results: Out of 12,524 coronary angiograms in de novo referrals, 372 (2.97%) showed significant LM stenosis; the proportion varied from 2.30% to 3.48% annually. LM patients’ mean age was 69.12 ± 9.75 years (22.95% women). No temporal age/gender trends could be identified. Overall, SS decreased from a mean value of 35 to 27 (Spearman correlation coefficient, SC = −0.17, p = 0.001). This was driven by reduction in non-LM-SS (SC = −0.18, p < 0.001) while LM-SS was not changing in time (SC = 0.04, p = 0.40). No temporal trends were present in LM stenosis segmental location (ostial/mid/bifurcation, p > 0.05 for all), its angiographic severity (< 70% vs. ≥ 70%; p = 0.35) or in the number of LM segments affected (p = 0.19). Isolated LM stenosis presentations increased over time (Z = 2.07, p = 0.039). The reduction in non-LM-SS was associated primarily with a trend towards reduction in number of coexisting non-LM lesions requiring revascularization (SC = −0.09, p = 0.07).

Conclusions: In consecutive patients presenting with de novo LM stenosis, angiographic SS showed a statistically significant negative trend over a decade, driven primarily by a reduction in non-LM-SS. Our findings are consistent with an increase in the proportion of patients presenting with LM stenosis amenable to first-line percutaneous (rather than surgical) management (LM-EVOLUTION study).